JPH02291850A - Sling for polyp excision - Google Patents

Abstract

PURPOSE: To avoid a short-circuit at the base of a loop by allowing two lead wires to float in the respective lumina of two flexible insulation tubes and by rotating one of the adjacent end parts to turn the loop. CONSTITUTION: When a slide member 28 is located most adjacently, remote end parts of lead wires 40&42 are contracted toward in the respective lumina of flexible plastic tubes 20&12. With this state, a loop assembly body 10 is inserted in the interior body organs by way of an endoscope. When the slide member 28 is pushed in to the remote direction, the wires 40&42 get out of the remote end parts 14 of both tubes and form an open loop because of their memory feature. A knob 39 on the wire 40 installed at the adjacent end part of the endoscope is operated, and a loop 46 is rotated surrounding the axis of polyp. A high frequency current is turned on and when a loop is closed by letting the slide member 28 retreat in the adjacent direction, an arc discharge is generated from electrodes 40&42; thereby, the axial tissue is rapidly cut off. The cap 44 of the end part of the insulation end part releases the end part of the wires 40&42 with the addition of a specified force.

Description

DETAILED DESCRIPTION OF THE INVENTION This invention relates generally to electrosurgical machines, and more particularly to improved electrosurgical machines used to remove polyps from internal body cavities. It is used for cerclage for polyp removal.

(Prior Art and Problems to be Solved by the Invention) U.S. Pat. It's made of airy plastic tubing. The outer diameter of this tube is small enough to allow it to pass through the lumen of the direct scope. Note that the remote raPIS of the 171k tube is provided with a lζ first electrode in the form of an annular metal cap.

The first wire constitutes a wire lube, which can be extended and retracted against the remote end of the tubular body. It is also capable of forming a loop around the polyp to be removed when inserted into the lumen of the straight scope, and by manipulating the handgrip member, the loop is capable of transmitting radio frequency energy. Said circular Ki 1? It can be applied between the tubercle and the wire loop, and then tightly drawn around the neck of the polyp. The tissue that makes up the polyp completes the circuit between the two electrodes, and if enough power is applied, the polyp's heart is eventually severed.

The 5A arrangement described in TiJ Patent No. 4.311.143 has several deficiencies. First, because the surface areas between the small annular cap electrode and the larger wire loop tiered at the end of the tube are not identical, the gold cap becomes the active electrode and the wire loop caps the tissue at the instep. It only serves the role of attracting people. Because of its shape, the gap tends to dry the tissue until the W-V lube becomes the active electrode and the impedance of the tissue is high enough to make the cut. This necessarily reduces the cutting action and exposes the surrounding healthy tissue to high temperatures for an extended period of time.

U.S. Pat. No. 4,493,320@Treat describes a double-lumen polinectomy snare that fits into a direct scope. In the same snare, a pair of wires is threaded through each of the lumens and extends beyond the distal end thereof, where the pair of wires are coupled with an insulating tip member.

Thus, the wire itself becomes an active bipolar pair.

However, this construction has the disadvantage that the snare loop exits the distal portion of the site in the wrong plane, often requiring the loop to be rotated at least 90° when it engages the polyp to be excised. There is. If one attempts to rotate the plane of the loop by twisting one or the other of the two wires at its distal ends, the loop twists at its base, creating a short circuit! There is a tendency for this to occur.

SUMMARY OF THE INVENTION The present invention provides a snare for polypectomy which overcomes the drawbacks of the devices of the two patents mentioned above. Rather than having the loop or snare be the first '4A and the toroidal end cap as the second sovereign, as in the Komise patent, the wood invention uses conductive material as in Tory's special edition. Sex Lou!
Alternatively, the snare may be effectively split, with one half forming the first electrode and the other half forming the second electrode.

By doing this, the contact area of one tissue between the two electrodes becomes the same. That is, one side does not become an invasion, and there is no high-frequency cut fli+' and only a heating effect occurs. However, the present invention solves the torsion problem seen in the snare of the Treat patent.

To achieve the foregoing advantages, the preferred embodiment comprises a polypectomy snare comprising a first elongate flexible plastic tube having a proximal end, a distal end, and a lumen extending therebetween. have.

A plastic tube of equal quality is provided coaxially with the first tube and loosely fitting within the lumen. A first electrical lead with an exposed metal distal portion extends through the lumen of the first tube from a terminal point at the mating end, and a second equal electrical lead extends into the lumen of the second tube. is extending.

These two conductors are thus electrically connected to each other in the region of the first tube, connecting the remote ends of the first and second conductors to form a loop. An insulating spacer is used for this purpose.
The same sube serves as an electrical insulating member between the two segments of #j lube.

A hand grip is provided connected to the proximal ends of the first and second plastic tubes, the first grip having a sliding portion on which the first or second conductive wire is fixedly mounted. The other of Niki's conductors passes through an S-wire slip ring mounted on the slide and exits the slide to reach the operating physician. Said other conductor is provided at its proximal end with a knob shaped like a mouthlet, by means of which a torque is applied to the wire in question, twisting the plane of the snare when necessary. It is believed that this is possible. By manipulating the handgrip, the loop can be expanded or contracted with respect to the remote part of the dupe through which the conductor passes. When the proximal YX7 pant is connected to a radio frequency power source and the snare is looped around the axis of the polyp to be excised, the tissue is tightened as the snare is tightened around the axis of the polyp. An arc is induced inside.

This arc quickly cuts into the heart, severing the polyp from normal tissue without overheating the surrounding tissue.

A significant advantage of the construction of the preferred embodiment when compared to the device described by Mr. Treat is that the two conductors are suspended within the respective lumens of the first and second bulbs. This means that it is possible to do 1111 things.

Thus, attempting to access the polyp by rotating one proximal end of the two *a and rotating the loop causes the wire at the base of the loop to twist;
It does not result in the loop being electrically disabled at that point. Instead, the wires are held physically separated from each other also by limited twisting and manipulation of the engagement device.

EXAMPLES Referring to FIG. 1, a high frequency polypectomy snare according to the present invention is designated generally by the numeral 10. As shown, the snare includes a first outer tubular member 12, preferably made of a flexible plastic material, and includes an I? 'J
The outer diameter of the S II is sufficiently small to allow it to pass directly into the lumen of a scope (not shown). The tubular member 12 has a distal end 14 and a proximal end 16. A lumen 18 extends the entire length of the member 12, and a second flexible plastic tubular member 20 is disposed within the lumen 18 and extends approximately coaxially with the outer tube 12. The second or inner tube 201 has a lumen designated by the number 22 (see FIG. 3).

Attached to the proximal ends 16 of the tubes 12 and 20 is a handgrip assembly that includes a molded plastic housing member 24. In addition, the member 24 has a longitudinal direction υJi 2 on its side.
6 is biased. Inside the housing 24 is a slide member 2.
8 is charged, and the i material is formed inside the housing 24 so that it runs within the 7C. Finger grip members 30 and 32 are integrally molded with the slide member 28 and extend through longitudinal splits 126 on opposite sides of the housing.

Note that portions 030 and 32 are shown here to be annular in shape to accommodate the index and middle fingers of one hand. A further ring 34 is attached to the proximal end of the housing 24 and is adapted to receive the user's thumb therein.

The grip members 30 and 32 further include a pair of terminals 36 and 38 to which the first or second wires 40 and 42 are attached.

The other of the two electric wires is attached to a slide member 28, and a conductive slip ring 3 is movable therewith.
It is inserted in 7. As seen in the remote view of FIG. 4, the slip ring 37 is then connected to the remaining one of the terminals 36. The output of a high frequency generator (not shown) is also connected to these two terminals via suitable leads.

(2) The wire 40 extends through the lumen of the inner tube 20 and beyond its remote m portion. Similarly, lead wire 42 is routed through lumen 18 of outer tube 12 and also extends beyond remote collar 14. At least six remote portions of wires 40 and 42 are bare metal and are mechanically connected to each other via ceramic buttons 44, but electrically isolated. The front fall wires are preferably stainless steel and are preformed at their distal ends to exhibit memory characteristics so that when unconstrained they form an open loop when wet. Also bottle or spike 4
5 protrudes from the button 44 as shown, and is adapted to hold loose polyp tissue once cut. The proximal end of the wire 40 passes through a slip ring member 37 as shown, and a notched plastic knob 39 is attached to the end to facilitate rotation of the wire 40 within the lumen. ing. Slip ring 37 allows ti from a high frequency generator to be applied to wire 40, but also allows the grip to be applied to v! It is also possible to make the loop 01 steel by retracting it.

In FIGS. 1 and 2, the slide 28 is
6 is also illustrated in its most advanced or remote position. Accordingly, the loop 746 defined by the end portions of sI 140 and 42 projects outwardly beyond the distal ends 14 of tubes 12 and 20. However, when the slide 28 is pulled rearward,
That is, when pulled in the proximal direction, wires 40 and 42
are retracted into their respective tubes 12 and 20 until the insulation button 44 contacts the distal end of the inner tube 2o.

In use, the high frequency generator has its output connected via cables to terminals 36 and 38 of the polypectomy snare. Terminal 38 is connected to slip ring 37. To the extent that wires 40 and 42 have most of their length contained within separate plastic insulating tubes, they are protected against short circuits. With the slide in its most proximal position, the distal end portions of leads 840 and 42 retract into their respective tube lumens. In this configuration, the snare assembly 10 can
Okito 1 easily gets into the body while trying to remove a polyp.
Rukoto can. By pushing the slide member 28 in the direction h, the wires 40 and 4 constituting the bipolar electrode are removed.
2 emerges from the distal end 14 of the tube and, because of the memory characteristics of the wire employed, springs into a loop, as best shown in FIGS. 1 and 3. By manipulating the knob 39 on the wire 4o attached to the proximal end of the direct mirror, the loop 46 can be rotated to align with the polyp and encircle the central axis of the peripheral polyp. be. If wire 4o is too thin to adequately transfer torque from knob 39 to loop 46,
The same wire can be provided with a nylon jacket (not shown) to enhance this property. Now, when the high-frequency power source is energized and the slide part shrine 28 is retracted in the approaching direction and the loop is opened again, the power supplies 40 and 42 surround the polyp axis at the point where arc discharge occurs. This allows the concentric tissue to be cut quickly. The end caps 44 are designed to pull the ends of the wires 40 and 42 apart when a force of appropriate strength is applied. Thus, if the tissue impedance becomes too high and the cutting action is interrupted, the instrument can be easily pulled free.

An important feature of the preferred 'X embodiment is the ability to rotate the snare 10 several times through complete rotation while keeping the wire loop stationary, as described in the prior art, 14th Revision 4.493.
．． This means that there will be no crossing or shorting of the electrodes as shown in FIG. 4 taken from 320@. Alternatively, by applying 1 lux to the loop by rotating knob 39 on conductor 40, conductor or wire 42
As best shown in the figure, inner tube 20
can move freely around the annular space surrounding it.

The snare for polyp removal according to the present invention is available in various markets +1! It can be manufactured from j materials. For example, various medical grade plastics can be used to mold the handgrip, but polycarbonate is preferred.6 The tubes 12 and 2o are made of extruded polyethylene, polyurethane, polyurethane, or )
It can be Teflon, but Teflon is preferred.

The conductors 40 and 42 are preferably formed from stainless steel, although other materials may be used. Furthermore, as the conductors travel the length of the tube, they 4. Since they are insulated from each other, there is no need to coat them with an insulator themselves.

In order to comply with patent law, the present invention also allows those skilled in the art to apply the new principles and construct the special parts required.
It has been explained in considerable detail to give you the information you need to use it. However, the invention can be implemented with particularly different equipment and devices! It will be appreciated that various modifications may be made to both the details of the device and the operating procedure without departing from the scope of the invention. ．．

[Brief explanation of drawings]

1 is a plan view of a polypectomy snare constructed in accordance with the present invention; FIG. 2 is a side elevational view of the device of FIG. 1; and FIG. 3 is a remote view of the polypectomy snare of FIG. 4 is a view of the distal end portion illustrating an alternative and alternative method of constructing a polypectomy snare in accordance with the prior art; FIG. 5 is a partial perspective view of the slip ring of FIG. 1; FIG. It is a partial view showing the stomach more accurately. 12... first tube, 14... remote end, 16
. . . Proximal end portion, 18 . . . Inner lumen, 20 .
8...Slide m material, 36.38...Terminal, 40.
42... First or second conducting wire, 37... Slip ring, 44... Insulated button, 39... Knob, 28...
・Slide member.

Claims (7)

[Claims] (1) An electrosurgical polypectomy snare comprising: (a) a first elongate flexible plastic tube having a proximal end, a distal end, and the proximal end of the first tube; (b) a second elongated flexible plastic tube having a proximal end, a distal end, and a lumen extending between a proximal end and a distal end; an end and a lumen extending between the remote end;
said second tube is a tube disposed within said lumen of said first tube; (c) a first electrical conductor having a proximal end and a distal end; (d) a second electrical lead having a proximal end and a distal end, the lead extending through the second tube; (d) a second electrical lead having a proximal end and a distal end; (e) an insulative spacer device for connecting said first and second electrical conductors at said remote ends thereof to form a loop; and (f) said first and second tubes. manually operable means coupled to said proximal end for imparting longitudinal translational movement to at least one of said first and second conductors to cause said first and second conductors to (g) a terminal arrangement provided at the proximal end of the conductor for connecting the conductor to a source of high frequency potential; (h) ) a device at the proximal end of one of the first and second conductors for transmitting rotational force to the first and second conductors; (2) The snare according to claim 1, wherein the outer diameter of the first tube is small enough to pass through a direct scope, and the outer diameter of the second tube is small enough to pass through the direct scope. A snare for polypectomy characterized in that it is allowed to move freely within the lumen of the first tube. (3) The snare of claim 1, wherein the first and second conductive wires are brought into contact with tissue to be cut;
A snare for removing a polyp, characterized in that it has a portion having approximately the same dimensions as the same tissue. (4) The snare of claim 3, wherein distal ends of said first and second conductors enter into open loops when extended outwardly from said lumens of said first and second tubes. A snare for polyp removal characterized by being made to burst out. (5) The snare of claim 1, further comprising a device for preventing said first and second conductive wires from twisting around each other, said twist preventing device being such that said loop is fixed. and is retained to prevent one of the first and second conductive wires from twisting as described above when rotated by the rotational force transmission device to transmit rotational force about its longitudinal axis. A snare for polyp removal characterized by: (6) The snare according to claim 1, wherein the terminal device includes a slip ring disposed around the one of the first and second conductive wires. hoof. (7) The snare according to claim 6, wherein the one of the first and second conducting wires passing through the slip ring is configured to transmit rotational force while maintaining electrical contact with the slip ring. Polypectomy snare, characterized in that it can be rotated by a rotational force transmission device and translated by said manually operable device.